- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $1,820.08 / $14,929.00
| Facility | | $100.00 | $1,820.08 | $14,929.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $910.04 / $910.04 / $910.04
| Facility | 52 | $910.04 | $910.04 | $910.04 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $364.02 / $364.02 / $364.02
| Facility | 53 | $364.02 | $364.02 | $364.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,975.00 / $37,708.00 / $37,844.00
| Facility | | $33,975.00 | $37,708.00 | $37,844.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,629.00 / $12,629.00 / $12,629.00
| Facility | | $12,629.00 | $12,629.00 | $12,629.00 |